Gärtner Rune, Callesen Torben, Kroman Niels, Kehlet Henrik
Department of Breast Surgery, Rigshospitalet, DK-2100 Copenhagen Ø.
Dan Med Bull. 2010 Feb;57(2):A4137.
Extant literature shows that women having undergone breast cancer surgery have substantial problems at the post-anaesthesia care unit (PACU). Based on nursing reports and elements of the discharge scoring system recommended by The Danish Society of Anaesthesiology and Intensive Care Medicine, the present prospective, observational study aims to determine why these patients stayed at PACU.
The study included 116 consecutive patients having undergone surgery for breast cancer. Postoperative nausea and vomiting (PONV), pain, sedation, respiration, oxygen saturation (SpO2), blood pressure and heart rate were scored at the PACU, and nurses were asked why discharge was delayed in case patients were not discharged at the time the discharge criteria were met. The outcome measures were the proportion of patients ready for discharge upon arrival at the PACU, patient time spent until discharge criteria were met, time to actual discharge, and the contribution of each discharge criterion in postponing discharge from the unit, as well as nurse-reported factors for the delay.
31% of the patients were ready for discharge upon arrival at the PACU. The mean time until the discharge criteria were met was 40 min (standard deviation (SD) = 46 min). The actual time spent at the PACU was 110 min (SD = 75 min). A total of 36 patients had low SpO2 (< 90%) upon arrival to the PACU. In 36 cases, discharge was delayed by the workload at the PACU and/or waiting for patient transport to the ward.
Low SpO2 (< 90%), the workload at the PACU and time spent waiting for transport to the ward were the primary reasons why patients stayed at the PACU after breast cancer surgery.
现有文献表明，接受过乳腺癌手术的女性在麻醉后护理单元（PACU）存在诸多问题。基于护理报告以及丹麦麻醉学与重症医学学会推荐的出院评分系统要素，本项前瞻性观察研究旨在确定这些患者留在PACU的原因。
该研究纳入了116例连续接受乳腺癌手术的患者。在PACU对术后恶心呕吐（PONV）、疼痛、镇静、呼吸、血氧饱和度（SpO2）、血压和心率进行评分，若患者在达到出院标准时未出院，护士需说明出院延迟的原因。观察指标包括到达PACU时准备出院的患者比例、达到出院标准所花费的患者时间、实际出院时间、各出院标准对延迟出院的影响，以及护士报告的延迟因素。
31%的患者到达PACU时已准备好出院。达到出院标准的平均时间为40分钟（标准差（SD）=46分钟）。在PACU实际花费的时间为110分钟（SD = 75分钟）。共有36例患者到达PACU时SpO2较低（<90%）。在36例病例中，出院延迟是由于PACU的工作量和/或等待将患者转运至病房。
SpO2较低（<90%）、PACU的工作量以及等待转运至病房的时间是乳腺癌手术后患者留在PACU的主要原因。
